
Spinal Cord (1998) 36, 716 ± 723
1998 International Medical Society of Paraplegia All rights reserved 1362 ± 4393/98 $12.00
http://www.stockton-press.co.uk/sc
Comparison of three methods to assess muscular strength in individuals
with spinal cord injury
Luc Noreau1,2 and JoeÈlle Vachon1
1
Rehabilitation Institute of Quebec City and 2Department of Rehabilitation, Laval University, Quebec City, Canada
The aim of the project was to compare three methods for measuring muscle strength in
individuals with SCI: the manual muscle test (MMT), the hand-held myometry and the
isokinetic dynamometry (Cybex). Thirty-eight (38) subjects, 31 men and seven women (age
range=14 ± 63; lesion from C5 to L3) were included in this project. Muscle strength
assessment of upper limbs was performed at admittance and discharge using MMT and
myometry for the left and right side, and using Cybex dynamometer for the stronger side. The
testing sessions were at least a day apart and performed by a single evaluator (trained
physiotherapist). Signi®cant and non-signi®cant di€erences of myometry mean strength values
were observed between consecutive levels of MMT. However, the range of myometry scores
within each MMT grade led to signi®cant overlaps between two adjacent MMT grades of each
muscle group. Variables correlations were observed between the strength values measured by
MMT and myometry with paraplegia (0.264r40.67) and tetraplegia (0.504r40.95). Similar
results were observed when compared MMT and Cybex with the stronger side.
Moderate to strong correlations were observed between the strength values measured by
myometry and Cybex with paraplegia (0.704r40.90) and tetraplegia (0.574r40.96). These
results suggest that the MMT method does not seem to be suciently sensitive to assess
muscle strength, at least for grade 4 and higher and to detect small or moderate increases of
strength over the course of rehabilitation. Since outcome measures is an important issue in
rehabilitation, objective measurements of strength should be used in clinical settings.
Considering cost and assessment time, the myometry technique seems to be highly valuable.
Keywords: isokinetic dynamometry; manual muscle test; myometry; spinal cord injury
Introduction
Medical rehabilitation is an important part of a
comprehensive rehabilitation process of individuals
with spinal cord injury (SCI). In the conventional
approach of caring for individuals with SCI, a major
focus is placed to forestall the occurrence of
secondary motor disabilities which can be induced
by a decrease in articular range of motion, balance
and muscle strength. Various strategies and treatments can be applied to attain this goal. Consequently, determining the e€ect of these interventions
is becoming a major issue in the context of assessing
cost-e€ectiveness in most rehabilitation facilities. A
key-element in the process of outcome measures is
the use of adequate techniques and instrumentations
to monitor the progress over the course of
rehabilitation.
The measurement of muscle strength is regularly
performed and is used in the rehabilitation process of
individuals with SCI for various purposes: neuroloCorrespondence: L Noreau, Rehabilitation Institute of Quebec City,
525 Boul. Hamel, QueÂbec, QC, Canada G1M 2S8.
gical classi®cation of injury, therapeutic planning and
outcome evaluation. A few methods are available for
assessing muscle strength such as manual muscle
testing, myometry and isokinetic dynamometry.
Manual muscle testing (MMT) is the most widely
used clinical method of strength assessment.1 It
grades strength according to the ability of a muscle
to act against gravity or against a resistance applied
by an examiner.2 ± 5 The frequent utilization of MMT
is largely attributable to the ease with which the
technique is performed in a short period of time and
with no speci®c cost of instrumentation. However,
the accuracy and the sensitivity of MMT is relatively
low.6,7 Beasley8 found that a variation of 25% in
muscle strength for the knee extensor cannot be
detected by MMT. Moreover, the force of a muscle
reaching only 50% of the `normal value' as measured
by objective techniques could be rated as `normal' by
MMT. Similar results were observed for hip
extensors and ankle plantar¯exors. The quotation
on a subjective ordinal scale requires a lot of
experience from the evaluator in order to limit the
in¯uence of potential compensation of the subject
Strength measurement in spinal cord injury
L Noreau and J Vachon
717
and to standardize the positioning. MMT may also
be sensitive to potential bias from the evaluator
regarding various age groups and gender. A few
studies reported a good level of reliability (intra and
inter-rater) within one grade, but there is no
consensus whether or not such a level of reliability
is sucient to support the MMT clinical utilization.6,7,9 ± 13
Myometry is a quantitative and objective method of
muscle assessment using a hand-held myometer (a
portable device) that can be easily manipulated in
various settings (physiotherapy rooms, at the side of a
bed). Intra and inter-rater reliability of the hand-held
myometry has been previously demonstrated with
able-bodied subjects.14,15 and subjects with neuromuscular or orthopaedic disorders.7,16 ± 18 This technique is
less sensitive to potential bias from the evaluator for
various age groups and gender.13 Nonetheless, the
isometric strength measurement might be in¯uenced by
the resistance that can be applied by the evaluator and
by the ability to hold the myometer in a stable
position, perpendicular to the segment.7,19 Myometry
requires much more time for positioning than MMT
and the initial cost of the device can be seen as a
limitation to its general use.
Isokinetic dynamometry might be considered as the
`gold standard' to assess muscle strength. Previous
studies have shown that reliable and reproducible
objective measurements of muscular strength can be
made with devices such as the Cybex II isokinetic
dynamometer.14 Its clinical use is, however, limited
because of its high cost, the dimension of the
apparatus, the time required for the subject's
positioning and the assessment procedures in some
conditions.20
Some studies were carried out to establish the
relationship between MMT and myometry. In
individuals with various impairments, Bohannon6
found a signi®cant correlation between MMT and
myometry (Kendall tau=0.74) for knee extensors.
Hayes18 found a much lower correlation for the same
muscle group in individuals with osteoarthritis
(Kendall tau=0.24). The magnitude of this relationship was speci®cally documented in individuals with
SCI. Schwartz13 found a variable association between
MMT and myometry (Spearman rank correlation
r=0.59 ± 0.94) for elbow ¯exors and wrist extensors
in 122 individuals with tetraplegia. The association
was stronger in lower grades (MMT54) while
substantial overlaps of strength values were observed
for two consecutive grades in the higher levels
(MMT54). Herbison21 compared changes in the
strength of elbow ¯exors after SCI as measured by a
hand-held myometer and MMT. Myometric measurements and their coecients of variations were greater
for each half grade di€erence in MMT. A wide
variability was reported in the myometric measurement of strength into one MMT grade, suggesting that
a hand-held myometer detected changes in muscle
strength not detected by MMT.
Only a few studies addressed the association
between myometry and isokinetic dynamometry.
Sullivan20 obtained a variable Pearson correlation
(r=0.52 on day 1 and r=0.78 on day 2) between the
two procedures when measuring isometric strength of
external rotators of the shoulder in able-bodied
individuals, while Bohannon19 reported an intra-class
coecient of 0.80 for the knee extensors. Bohannon22
obtained an intra-class coecient over 0.94 between
the two procedures for isometric knee extension torque
in stroke patients. Surburg23 obtained a good
correlation (Pearson r=0.74 for knee extensors,
r=0.77 for elbow ¯exors) in individuals with mental
retardation.
To our knowledge, no published study has been
performed to determine the magnitude of the
association between the three procedures (MMT,
myometry and isokinetic dynamometry) to assess
muscle strength in individuals with SCI. Therefore,
the aim of the project was to compare the three
methods of measuring muscle strength in individuals
with SCI: manual muscle testing (MMT), hand-held
myometry and isokinetic dynamometry.
Methodology
Thirty-eight (38) individuals with SCI admitted at the
Rehabilitation Institute of Quebec City (RIQ) were
included in this project. Level of SCI ranged from C5
to L3. Level and severity of injury were assessed
according to American Spinal Injury Association
standards for neurological classi®cation of spinal
injury patients. When the health status of the person
permitted it, (usually within the ®rst 2 weeks after
admittance into the rehabilitation center), each subject
was met and explained the assessment procedure which
was part of a larger project on rehabilitation
outcomes. Exclusion criteria were as follows: level of
injury higher than C5, unstable medical condition
(deep venous thrombosis, heart disease, diabetes,
symptomatic hypotension, unstable fracture), admittance exceeding 3 months post-injury. All participants
signed an informed consent form after the objectives
and procedures of the study were described as
approved by the RIQ Committee on Human Experimentation. Table 1 presents the characteristics of the
sample.
Muscle strength was measured for six upper limb
muscle groups (elbow ¯exors-extensors, shoulder
¯exors-extensors, and shoulder abductors-adductors)
at admittance and discharge. Both sides were assessed
by manual muscle testing (MMT) and myometry, and
the stronger side by isokinetic dynamometry (Cybex).
The three procedures were performed at least 1 day
apart over the course of 1 week. The myometry and
the isokinetic dynamometry were performed by a
single evaluator (a trained physiotherapist). MMT
was also carried out by this evaluator when the usual
clinical evaluation reported a score of 4.5 or less.
Strength measurement in spinal cord injury
L Noreau and J Vachon
718
Manual muscle testing
Modi®ed MMT was performed in standardized
positions.2,3,5,24 For the elbow ¯exors and extensors,
and the shoulder adductors, the subject was in a supine
position. For the shoulder ¯exors, extensors and
abductors, the subject was sitting on a wheelchair
and the evaluator stabilized the trunk, if necessary. For
each muscle group, the subject was asked to perform
the movement with or without gravity, or against a
resistance according to the level of strength that can be
generated. The resistance applied distally to the
segment by the therapist was measured subjectively
on a 10-grade scale adapted from the Modi®ed Medical
Research Council Scale (Table 2).25
Table 1 Characteristics of the sample
Age (years)
Sex
Severity of lesion (ASIA)*
grade at admittance
Time since injury
(months)
Length of stay (days)
Paraplegia
(n=23)
Tetraplegia
(n=15)
28.2+13.9
30.1+13.4
M=18
F=5
M=13
F=2
A=15
B=3
C=1
D=4
A=6
B=6
C=3
D=0
admittance
1.6+0.7
discharge
4.3+1.1
82.8+23.4
admittance
2.1+2.1
discharge
7.9+3.2
176.0+67.2
*Neurological classi®cation of spinal injury patients
Table 2 Manual muscle strength testing grade scale used for
the MMT procedure*
Grade
scale
0
1
1.5
2
2.5
3
3.5
4
4.5
5
Description
no muscle contraction
trace muscle contraction
muscle can perform partial range of motion with
gravity eliminated
muscle can perform full range of motion with
gravity eliminated
muscle can perform partial range of motion against
gravity
muscle can perform full range of motion against
gravity
muscle can perform full range of motion and
provides a slight resistance
muscle provides moderate resistance
muscle provides considerable resistance but not
quite normal
normal muscular strength
*Adapted from the Modi®ed Medical Research Council Scale
Myometry
A Penny and Giles hand-held myometer was used to
measure maximal isometric strength of the six muscle
groups as described by van der Ploeg26 and Lennon.27
All muscle groups were assessed with the subject in a
supine position. Elbow ¯exors and extensors were
tested with the shoulder adducted to the trunk, the
elbow ¯exed to 908 and the forearm placed in a neutral
position relative to pronation and supination. The head
of the myometer was placed proximally to the styloid
processes. Shoulder ¯exors and extensors were tested
with the ipsilateral shoulder ¯exed to 908, the arm
placed on the neutral position of rotation and the
elbow ¯exed to 908 (the forearm was ®xed by the
evaluator if needed). The head of the myometer was
placed proximally to the humeral epicondyles.
Shoulder abductors and adductors were tested with
the ipsilateral shoulder abducted to 908, the arm placed
on the neutral position of rotation and the elbow ¯exed
to 908 (the forearm was ®xed by the evaluator if
needed). The head of the myometer was placed
proximally to the humeral epicondyles.
The sequence for the tests followed the order as
above. For each procedure, the subject was instructed
to perform a maximal contraction with a rest period of
10 s between each trial (n=3). The evaluator stabilized
the myometer to ensure an isometric test, and
consistent verbal encouragement was provided to the
subjects. The mean value of the three trials was used
as the strength data for each muscle group.
Isokinetic dynamometry
Assessment was performed with a calibrated Cybex II
isokinetic dynamometer set at 608/s. The six muscle
groups were tested on the stronger side only, which was
previously determined by the trained physiotherapist
according to the results of muscle strength recorded
from the myometry procedure. The subject was
transferred to the upper-body exercise and testing
table (U.B.X.T.) and stabilized by three velcro straps
(chest, pelvic, legs). Elbow ¯exors-extensors and
shoulder ¯exors-extensors were consecutively assessed
with the subject lying supine. For the elbow muscle
groups, the shoulder was abducted to 908, the arm
positioned on a support, the elbow ¯exed to 908. For
the shoulder muscle groups, the shoulder was adducted
to the trunk and the elbow extended. In both cases, the
subject held the hand grip or the hand was ®xed with a
glove, if necessary. The respective joint axes were
aligned with the dynamometer input shaft, and
blockers ensure a constant and normal range of motion.
Shoulder abductors-adductors were assessed with
the subject sitting with a thigh-trunk angle of 458. The
shoulder adducted to the trunk, the elbow extended,
and the hand ®xed on the hand grip with a glove, if
necessary. The joint axis was aligned with the
dynamometer input shaft tilted at 458. Cushions
placed at the two extremities of the course ensured a
constant and normal range of motion.
Strength measurement in spinal cord injury
L Noreau and J Vachon
719
After an appropriate warm-up, the subjects were
asked to perform ®ve biphasic maximal contractions
for each muscle group. During the test, consistent
verbal encouragement was provided to the subjects.
The peak torque generated by each muscle group was
recorded as maximal strength.
Statistical analysis
Distributions of muscle strength (myometry and
dynamometry) for each MMT level was displayed
using box plots. An analysis of variance and tests of
multiple comparisons (Tukey) were used to identify
signi®cant di€erences of mean myometric values
between consecutive MMT levels. Spearman correlations were used to determine the strength of association
between MMT and myometry, and Pearson correlations were used to illustrate the association between
myometry and dynamometry scores (for the stronger
side of upper limb). Signi®cance for all statistical
analyses was ®xed at the 0.05 level.
Results
The strength values of each muscle group (myometry)
are graphically displayed for the MMT levels. The
distributions of strength values for each muscle group
showed a large range with extensive overlaps within most
MMT levels in both types of injury (paraplegia and
tetraplegia). Thus, data from all subjects were grouped
together (Figures 1 ± 3). Despite this variability, a
progressive increase of myometry mean strength values
was observed between most consecutive levels of MMT.
Signi®cant and non-signi®cant di€erences of mean
values were noted. Nonetheless, for all muscle groups,
the distribution of strength values showed large overlaps
between all pairs of adjacent MMT scores for grade 4
and higher. Between grades 3.5 and 4, this overlap was
less important for the elbow extensors, shoulder
extensors and adductors. Between grades 3 and 3.5,
more distinct di€erences with smaller overlaps was
observed except for shoulder abductors.
Variable levels of association were observed between
the strength value measured by MMT and myometry in
individuals with paraplegia (0.264r40.67) or tetraplegia (0.504r40.95) (Table 3). The highest correlations were found with the elbow extensors, the shoulder
¯exors and the shoulder adductors in tetraplegia. All
other correlations were low or moderate. We noted that
the correlations decreased at discharge for three muscle
groups in paraplegia (elbow ¯exors, shoulder abductors
and adductors) and for most muscle groups in
tetraplegia (except shoulder abductors).
Comparisons between adjacent MMT grades were
also performed for the strength values measured by
dynamometry. Overlaps of comparable magnitudes
between consecutive MMT grades were observed for
the stronger side of each muscle group. Similar
correlations were also observed between the strength
values measured by MMT and dynamometry in
individuals with paraplegia (0.194r40.65) or tetraplegia (0.354r40.91).
<
Figure 1 Muscle strength of elbow ¯exors and extensors (right and left side) measured by myometry and MMT in individuals
with SCI (n=38)
Strength measurement in spinal cord injury
L Noreau and J Vachon
720
Finally, moderate to strong correlations were
observed between the strength values measured by
myometry and dynamometry in individuals with
paraplegia (0.704r40.90) or tetraplegia (0.574
r40.96) (Table 4). The lowest correlations were
observed with the elbow extensors and the shoulder
<
Figure 2 Muscle strength of shoulder ¯exors and extensors (right and left side) measured by myometry and MMT in
individuals with SCI (n=38)
<
Figure 3 Muscle strength of shoulder abductors and adductors (right and left side) measured by myometry and MMT in
individuals with SCI (n=38)
Strength measurement in spinal cord injury
L Noreau and J Vachon
721
Table 3 Spearman correlation coecients between the strength values measured by MMT and myometry for six muscle groups
(tested on both sides) in individuals with SCI (n=38)
Muscles
Elbow ¯exors
Elbow extensors
Shoulder ¯exors
Shoulder extensors
Shoulder abductors
Shoulder adductors
Paraplegia (n=23)
Admittance
Discharge
0.48
0.46
0.63
0.44*
0.64
0.67
0.26<
0.55
0.60
0.49
0.57
0.34*
Tetraplegia (n=15)
Admittance
Discharge
0.58
0.95
0.83
0.67
0.55*
0.84
0.48*
0.88
0.50*
0.57
0.59
0.73
*0.0015P40.05, otherwise P40.001. <P=0.084
Table 4 Pearson correlation coecients between the strength values measured by myometry and isokinetic dynamometry for
six muscle groups (tested on stronger side) in individuals with SCI (n=38)
Muscles
Elbow ¯exors
Elbow extensors
Shoulder ¯exors
Shoulder extensors
Shoulder abductors
Shoulder adductors
Paraplegia (n=22)a
Admittance
Discharge
0.76
0.70
0.89
0.85
0.73
0.81
0.75
0.82
0.89
0.83
0.82
0.90
Tetraplegia (n=15)
Admittance
Discharge
0.81
0.92
0.82
0.59*
0.57*
0.91
0.75
0.96
0.78
0.87
0.76
0.90
*0.0015P40.05, otherwise P40.001 aone missing value
abductors in paraplegia, and with the shoulder
extensors and abductors in tetraplegia. We noted that
the correlations increased at discharge for three muscle
groups in paraplegia (elbow extensors, shoulder
abductors and adductors) and for two muscle groups
in tetraplegia (shoulder extensors and abductors).
Discussion
The aim of this project was to establish the relation
between manual muscle testing (MMT), hand-held
myometry and isokinetic dynamometry for determining the most appropriate method of measuring muscle
strength in individuals with SCI. To our knowledge,
this is the ®rst study addressing the relation between
these three procedures in individuals with spinal cord
injury. The results of this study showed a variable
relationship between MMT and myometry. Conversely,
moderate to strong associations were observed between
myometry and isokinetic dynamometry. One of the
main ®ndings of this study is the large overlap of
strength values recorded by myometry between
consecutive MMT grades.
As expected, an increase of mean myometry values
corresponded to a proportional increase of MMT
scores. This ®nding has been previously observed in
individuals with SCI.13,21 Between consecutive levels of
MMT, there existed signi®cant di€erences of mean
myometry values. Some di€erences, however, were not
signi®cantly detectable due to a small sample size of
some speci®c MMT levels (potential type II error). For
example, we can hypothesize that the means of the 3
and 3.5 grades of the shoulder ¯exors and the shoulder
adductors (Figures 2 and 3) were suciently distinct to
be signi®cant in a large sample.
Results also revealed a large variability in the
myometry values within each MMT grade. This
variability and the observed overlapping is progressively emphasized as the MMT grade increases. In
fact, we observed much variability and overlapping of
the myometry values for all muscle groups rated four
or more. These ®ndings correspond to previous
observations in able-bodied subjects28 and in individuals with SCI.13,21 For most grades 3.5, less
variability of myometry values were present and the
overlapping with grades 4.0 was smaller, except for the
shoulder ¯exors and abductors. A potential explanation for the MMT's lower accuracy for the latter two
muscle groups might come from di€erent subject's
positioning. While the subjects are lying in supine
position for myometry procedure, they are seated in a
wheelchair for the MMT procedure of shoulder ¯exors
and abductors which inherently provides less trunk
support as the evaluator applied resistance to the
tested body segment. This might in¯uence the
evaluator's quotation. Likewise, the muscle group
being evaluated must overcome the force of gravity
in the sitting position. Low variability and light
overlapping were observed at MMT grades 3 and 3.5
for ®ve out of six muscle groups. These results
Strength measurement in spinal cord injury
L Noreau and J Vachon
722
con®rmed Schwartz's13 observations that the range of
myometry values for a particular MMT grade appears
to be most speci®c for MMT scores less than 4. The
unexpected result for the shoulder abductors might
also be partly explained by the lack of trunk
stabilization in the wheelchair.
Low to moderate correlations between MMT and
myometry were observed in individuals with paraplegia. Actually, the majority of muscle groups
evaluated obtained MMT scores of four or more.
The large variability and overlapping observed for
these MMT scores explain this low correlation. As
described by Schwartz,13 in the case of a large
overlapping between myometry values and MMT
consecutive grades, correlation between the two
procedures decreases. In individuals with tetraplegia,
we noted that the correlation is generally stronger but
tended to decrease upon discharge in comparison with
admittance which might be due to the enhancement of
strength over the course of rehabilitation, given that
small gains may not be observable with MMT.
A second element could also explain in part these
low correlations. To measure the strength of muscles
rated 43 with the MMT, the usual procedure is a
break test. In the present study, the procedure adopted
with the myometer consisted of using a make test.
Bohannon29 found a signi®cant di€erence in the force
produced during make tests and break tests, with a
greater force produced during the latter one. This
®nding suggests that the muscle strength graded by
MMT might be over estimated in relation to the ones
evaluated by the myometer. Bohannon6 was already
proposing such an explanation when comparing the
MMT and the myometer for knee extensors.
For most muscle groups, moderate to strong
correlations were observed between the strength
values recorded by myometer and isokinetic dynamometer. The lowest correlations were observed for the
shoulder extensors and abductors in individuals with
tetraplegia at admittance. However, we noted that the
same correlations are those showing the greatest
increases at discharge. This suggests that while the
subject shows a low level of muscle strength (at
admittance), the speci®c procedure for these two
muscle groups using Cybex dynamometer present
very signi®cant execution problems for individuals
with tetraplegia, which limit their capabilities of
producing a maximum e€ort. Indeed, the evaluation
position for the shoulder abductors requires the
subject to overcome gravity for the whole range of
motion, which intensi®es the test's diculty for
subjects with a weak muscle strength. Shoulder
extension can also present execution diculties when
the subject has to overcome gravity in order to initiate
movement starting from a complete shoulder ¯exion.
Another element increasing the diculty of the
procedure is the lack of joint proximal stability. For
example, the shoulder needs to be stabilised by the
®xators in individuals with SCI to generate representative maximal e€orts across the joint. Therefore, the
capabilities of producing real maximal contractions
may be a€ected by a lack of passive stabilization of
the shoulder girdle attributable to secondary laxity or
to muscle imbalance.
Other factors might have limited the relationship
between strength values recorded by myometer and
isokinetic dynamometer. First, in this study, we
compared an isometric force (myometer) with an
isokinetic force (Cybex). Given that some studies
supported the concept of speci®city of muscle
strength,30 the inherent di€erences between the two
methods might a€ect their association. Nonetheless,
the correlations obtained in this study were similar to
those reported by previous studies using both
procedures in isometric mode.20,23 Second, we also
used di€erent positions to evaluate certain muscle
groups. For example, shoulder abductors and adductors were assessed in a 458 sitting position with Cybex
while gravity was eliminated with the myometer. For
the elbow ¯exors and extensors, we modi®ed the
shoulder position which was ®xed at 908 of abduction
for the Cybex and the arm was adducted to the trunk
for the myometer. Bohannon31 demonstrated a
signi®cant di€erence in the strength of the elbow
extensors in¯uenced by the shoulder's position of ablebodied subjects. Third, the lever arm on which
resistance is applied is also very di€erent for the two
procedures. For the myometer, the apparatus' head is
applied distally for the evaluated segment while for
Cybex the subject held a handle in his hand. In the
latter way, the hand transmitted the shoulder or
elbow's torque to the apparatus. Likewise, the lever
arm is much longer and even crossed two joints for the
shoulder muscle testing, which requires good muscle
control of the evaluated joints. Sullivan20 discussed the
necessity of good control of the wrist's ¯exion/
extension to explain these inter-instrument correlations for the shoulder's external rotators. The variable
level of the person's stabilization between the two
procedures could also in¯uence the strength measurements.
Conclusion
The present study compared three methods for
measuring muscle strength in individuals with SCI:
MMT, myometry and isokinetic dynamometry.
Despite its wide use, MMT does not appear to be
suciently sensitive to determine improvements in
muscle strength over the course of rehabilitation. Its
accuracy is acceptable for muscle groups with low
MMT scores, but is de®nitely unsuitable for MMT
scores of four and higher. Given the increased
importance of outcome measures in rehabilitation,
an objective method for the measurement of muscle
strength should be strongly encouraged in clinical
settings. Considering the cost and time required for
assessment, myometry is obviously a valuable
procedure to obtain an accurate evaluation of
improvement in muscle strength.
Strength measurement in spinal cord injury
L Noreau and J Vachon
723
Acknowledgements
The authors are pleased to acknowledge the contributions
of the clinicians of the RIQ spinal cord unit for their
technical support and the commitment of all participants
to the project.
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